Pablo Gerardo Sánchez

Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória

OBJECTIVE: To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma. METHODS: A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death. RESULTS: The postoperative (30-day) mortality rate was 2.9%, and the postoperative complications index was 44%. Prolonged air leakage was the most common complication (in 20.6%). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 ± 4.4), forced expiratory volume in one second (74.1 ± 24%) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 ± 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01). CONCLUSION: Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients submitted to lobectomy for the treatment of bronchial carcinoma. Air leakage was found to be strongly associated with mortality.

Avaliação da resposta de pacientes asmáticos com refluxo gastroesofágico após terapia com pantoprazol: estudo prospectivo, randomizado, duplo cego e placebo-controlado

OBJECTIVES: To determine the effect that the treatment of GERD has on the clinical management, as well as the respiratory function, of patients with asthma and to evaluate the clinical characteristics of this group of patients. METHODS: Patients with asthma and concomitant GERD, documented using 24 h pH-metry, were evaluated by means of quality of life questionnaires, as well as questionnaires related to respiratory and digestive symptoms. In addition, esophageal manometry, spirometry and the determination of peak expiratory flow were also performed prior to and after the study. Forty-nine individuals who were diagnosed with GERD by means of 24 h esophageal pH-metry were selected and participated in a clinical randomized double-blind placebo-controlled study, involving the administration of 40 mg/day of pantoprazol for 12 consecutive weeks. RESULTS: Forty-four individuals completed the study (n = 22 per group). There was significant improvement in the scores for respiratory symptoms and quality of life only in the group that received pantoprazol (p = 0.01 and p = 0.001, respectively). No respiratory function parameters changed in either group. CONCLUSIONS: In this study, the effective treatment of GERD improved patient quality of life, and the symptoms of asthma significantly decreased in the group that received the medication. There were no changes in pulmonary function parameters.

Pré-condicionamento isquêmico por oclusão seletiva da artéria pulmonar em ratos

OBJETIVO: Avaliar o efeito do pre-condicionamento isquemico (PCI) em modelo de isquemia e reperfusao (I/R) pulmonar normotermica em ratos, quantificando a producao de especies reativas do oxigenio. METODOS: Quarenta e sete ratos Wistar foram randomizados em quatro grupos: controle, sham, I/R e PCI. Apos anestesia, animais do grupo controle foram sacrificados por decapitacao, pneumonectomizados, e os pulmoes esquerdos armazenados em nitrogenio liquido. Animais dos grupos sham, I/R e PCI foram anestesiados, traqueostomizados, ventilados, anticoagulados e submetidos a uma toracotomia esquerda com disseccao da arteria pulmonar esquerda para clampeamento. No grupo sham procedeu-se a disseccao da arteria pulmonar esquerda; no grupo I/R, clampeamento hilar total de 30 min e no grupo PCI, clampeamento da arteria pulmonar esquerda por 5 min seguido por reperfusao de 10 min e um clampeamento hilar total de 30 min. Pulmoes foram reperfundidos por 90 min e ventilados com os mesmos parâmetros, acrescidos de pressao expiratoria final positiva de 1 cmH2O. Foram obtidas medidas hemodinâmicas e gasometricas antes da toracotomia, antes do clampeamento hilar total, aos 30 e 90 min de reperfusao. A peroxidacao lipidica foi estabelecida por meio da determinacao das substâncias reativas ao acido tiobarbiturico. RESULTADOS: A determinacao das substâncias reativas ao acido tiobarbiturico analisada nos grupos controle, sham, I/R, PCI nao revelou diferencas significativas, o mesmo ocorrendo com a pressao parcial arterial de oxigenio, pressao parcial arterial de gas carbonico e medidas hemodinâmicas entre os grupos sham, I/R e PCI. CONCLUSOES: O PCI de 5 min da arteria pulmonar esquerda em modelo de I/R in situ em ratos nao atenua a lesao de I/R.

Modificação da técnica de alotransplante pulmonar unilateral em ratos

The increasing demand in transplantation research requires efficient and less expensive animal models in order to obtain reliable results that are reproducible in larger animal models and, ultimately, applied clinically. The model of unilateral left lung transplantation in rats has proven to be a useful alternative for those purposes. We demonstrate a technical modification of this model, which consists of the isolation and ligation of the contralateral (right) pulmonary artery, allowing blood circulation exclusively in the transplanted lung. This model is feasible and reproducible. However, the short survival time restricts the assessment of the transplanted lung to a maximum period of three hours.

Blastoma pulmonar: tratamento cirúrgico por lobectomia superior direita e broncoplastia

Pulmonary blastoma is a rare lung tumor that is composed of malignant epithelial and mesenchymal cells. It presents a pattern of rapid growth. Herein, we report the case of a patient with hemoptysis and a mass in the right upper lobe. The patient presented limited pulmonary function, and fiberoptic bronchoscopy revealed invasion of the intermediate bronchus. The patient underwent sleeve resection of right upper lobe, a technique never before described. After 36 months of follow-up, the patient remained asymptomatic. We also review the literature regarding treatment, clinical aspects and pathology.

Pseudotumor inflamatório endobrônquico: relato de caso

Inflammatory pseudotumor of the lung is a rare form of benign neoplasia and is generally characterized by a solitary pulmonary nodule. The endobronchial presentation is uncommon. Conservative surgery remains the treatment of choice, and surgeons should always strive to achieve tumor-free margins due to the possibility of local recidivism. This article reports the case of a 36-year-old male patient with recurrent attacks of wheezing and cough. The patient underwent successful bronchoplasty for the resection of an endobronchial inflammatory pseudotumor.